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Uterine fibroids: symptoms and signs, treatment, pregnancy

Uterine fibroids, what is it and is it dangerous? Sooner or later, this question begins to interest almost every woman, given the high prevalence of pathology. Uterine fibroids are a benign tumor emanating from the muscle layer of the uterus and not prone to malignancy. The danger of pathology can be described in simple words dry numbers.

World statistics is relentless - according to her data, the removal of the uterus most often occurs due to fibromyoma. Everything would be fine, but up to 10% of cases are women younger than 30 years old who still want to have children.

In addition, in Russia, every third child is born a woman at the age of 35 years. . Therefore, young patients (up to 35 years old) are required to undergo an organ-preserving treatment, which modern medicine can already offer .

Uterine fibroids

It can be not only operative minimally invasive interventions, but also the use of pharmacological drugs belonging to the new class. Every year the selectivity of their actions, and accordingly, the effectiveness and safety, increase, because scientific developments in this direction are not ceasing, but are becoming larger.

Content

Causes of uterine fibroids, development

The causes of uterine fibroids throughout the entire period of the study of this tumor have changed dramatically and supplemented. It used to be considered a dogma that fibromyoma occurs as a result of hereditary mutations (which means it should always manifest itself in descendants along the female line) in the cells that form the muscular layer of the uterus (myometrium).

These mutations are not innate, they are acquired in the process of life due to the on-off of certain genes, so they can be controlled. However, it is impossible to completely deny that fibromyoma:

  1. Has a family predisposition.
  2. It is more common in Negroid women.
  3. Both monozygous twins get sick more often, i.e. absolutely identical.

Scientists have identified certain factors that provoke the development of cellular mutations in fibromyoma. This means that the probability of developing a tumor can be influenced. Previously, it was believed that it was impossible to do, because "Diseased genes" are not modifiable (changeable).

Causes of uterine fibroids

So, predispose to the development of fibroids such factors as:

  • Injury of the uterus during childbirth (however, not all childbirth is a trauma, but only complicated);
  • Injuries during abortions;
  • Inflammatory diseases of the uterus or appendages;
  • A large number of menstrual cycles throughout the life of a woman (because of this, the uterus cannot recover to the proper extent, and the process of its restoration occurs with violations, it is not physiological);
  • The pain of menstruation (algodysmenorrhea), because it is accompanied by pronounced ischemic (oxygen-deficient) changes in the myometrium.

With uterine fibroids, there is an active reproduction of not only smooth muscle cells, but also the formation of collagen fibers located between them. The size of the tumor depends on these two components.

In the process of recent research, it was found that a certain life cycle is characteristic of any fibroids:

  • Initially, initiation of its growth is observed;
  • Later, the progression and stabilization (the reason for this is an increase in the number of vessels);
  • And in the end, cell death and tumor involution resulting from a decrease in the number of blood capillaries (this is recovery).

Therefore, if there are no additional stimulating factors, then the involution (disappearance) of the tumor is a natural process. This happens in most cases when the disease is asymptomatic or with minor clinical symptoms.

Minimally invasive treatment methods (embolization and FUS ablation) are based on this effect of ischemia and the end of the life cycle.

It is necessary to touch and hormonal theory , dominant for a long time. It was believed that the development of the tumor is associated exclusively with the state of hyperestrogenemia (elevated estrogen content).

However, it has now been proven that the initiation of myoma node growth and its progression occur while simultaneously increasing estrogens and progesterones. Thus, in the tumor nodules, the concentration of receptors for both hormones is increased. Recently, the opportunity to explain this phenomenon.

The fact is that these sex hormones lead to the synthesis of specific substances that are the factors of vascular growth. It is this process that leads to the uncontrolled reproduction of cells and the formation of collagen fibers. In contrast, under the conditions of ischemia, the reverse process is observed - involution.

Therefore, the pharmacological effect on progesterone receptors in the form of their selective blocking creates the conditions (reduces the number of newly formed vessels) for the natural disappearance of fibroids.

This was the prerequisite for the creation of a new class of drugs for the treatment of fibroids. They turned out to be highly effective and do not lead to the growth of nodes after their cancellation. This often avoids surgery.

Signs and symptoms of uterine fibroids

Signs and symptoms of uterine fibroids

The clinical signs and symptoms of uterine fibroids may be minimal or absent. The presence of pronounced symptoms, observed in 30% of cases, can significantly reduce the quality of life of a woman.

The main symptoms of uterine fibroids that appear in these patients are:

  1. Pain in the lower abdomen.
  2. Bleeding and bleeding on non-menstrual days.
  3. Increased urination.
  4. Tendency to constipation.
  5. Slight fever.
  6. Pain and weakness in the legs (these are manifestations of the nerve root compression syndrome with tumor sizes of more than 14 weeks).

Fibroids of the cervix is a specific type of myomas, which is very rare. It manifests itself in several other signs:

  1. Spotting during intercourse (due to injury to the node).
  2. The pains of the cramping character associated with the "birth" of myoma node.
  3. Infertility

Diagnostics

Diagnosis of fibroids is carried out according to the results of a comprehensive survey:

  • Vaginal examination (tumor size is compared to weeks of pregnancy)
  • Ultrasound scan of the uterus and thyroid gland (pathology is observed in 70-80%, therefore a combined examination is recommended)
  • Doplerometry - assessment of blood flow in the uterus
  • General clinical blood test (decrease in hemoglobin is determined with frequent and prolonged bleeding)
  • MRI and Hysteroscopy - examination of the uterus from the inside with a special magnifying device.

Treatment of uterine fibroids

Treatment of uterine fibroids

Treatment of uterine fibroids without surgery is the goal of modern gynecology. It can be achieved by several methods:

  1. Embolization of the artery supplying myoma node.
  2. FUS ablation (focal ultrasonic cautery).
  3. The use of pharmacological drugs (especially promising are the selective modulators of progesterone receptors, created in 2012).

The use of minimally invasive techniques for the treatment of fibrioma (embolization and FUS ablation) is associated with the risk of recurrence. It ranges from 15 to 45%.

However, an important advantage of such treatment is the preservation of an organ that performs both menstrual and reproductive functions. And this is an opportunity to have a baby and feel like a full-fledged woman.

Conservative treatment of uterine fibroids should be top priority if:

  • A woman is still planning a pregnancy.
  • The woman’s age is approaching menopause (cessation of hormonal influences).
  • There are contraindications to the operation.

Drug therapy is one of the promising methods of conservative treatment of fibroids. It is not only a stage of preoperative preparation, but also an opportunity to refuse surgical treatment.

The goals of such therapy are:

  1. Slowing the growth rate of the node.
  2. Stimulation of involutive processes of fibroids.
  3. Elimination of clinical symptoms (most commonly bleeding and pain).

The groups of drugs used in drug therapy at the present time are diverse. But they are not specialized in view of modern achievements in gynecology, therefore, they require revision.

More detailed information about them will help a woman not to be held hostage by the doctor’s ignorance . This information will help to find a real expert who owns modern achievements of science, designed to preserve the organ as much as possible and treat it.

1. Combined hormones for contraception are not specialized, but to date have been widely prescribed by Russian doctors. Their therapeutic effect for fibroids is minimal. They can only slow down the growth of the node and only if its diameter does not exceed 2 cm.

They do not reduce the size of existing nodes. In addition, there may be situations where myoma receptors may be sensitive to the components of the drug, which leads to a rapid growth of the tumor.

2. The agonists of releasing gonadoliberin (buserelin) provoke the development of menopause for the period of their administration. Their significant drawback is the short duration of the therapeutic effect.

Within six months - a year, the sizes of the nodes return to the original, and even more. A long-term use of these drugs is impossible because of the serious side effects associated with the state of menopause.

3. Progestogens (the local form is Mirena's advertised intrauterine device) - there is no evidence base of effectiveness. However, it is known that they do not reduce the size of fibroids.

4. Antigestagens are a modern and effective treatment for fibroids, opening up new horizons.

The drug of the first generation is Mifepristone. But in addition to blocking progesterone receptors, it can interact with other receptor systems, for example, glucocorticosteroid.

The second-generation drug, devoid of this deficiency, selectively acting on progesterone receptors, is Esmia. He was registered in Russia in 2013.

The advantage of the drug is the absence of the menopausal effect. "Esmia" causes cell death in myomatous node, therefore, after cancellation, they do not grow. Reduced severity of bleeding and pain by the 10th day.

The duration of the course of treatment is 3 months, then, depending on the degree of knot reduction, a repeated course may be required.

Folk treatment of uterine fibroids (herbs, iodine, etc.) cannot be recommended, because it only leads to loss of time.

And against this background, there is a growth of nodes, which can lead to the need to repeat courses of conservative therapy (they are quite expensive, albeit effective - the package “Esmia” costs about 10,000 Russian rubles).

In advanced cases, the loss of time can lead to the formation of large myomas and other complications in which only complete removal of the uterus is required.

Another method of treatment is the removal of uterine fibroids as part of a conservative myomectomy (the node is removed, and the uterus remains). It is carried out according to strict indications:

  • The desire to become a mom.
  • The clinical signs of uterine fibroids are not significant.
  • The size of the tumor is not more than 12 weeks.
  • The location of the nodes under the serous membrane (outer part of the uterus) or in the intermuscular layer.
  • High risk of anesthesia and abdominal surgery for concomitant diseases.

Unreasonably, the most common type of surgical procedure at the present time is the complete removal of the uterus (hysterectomy).

Such a high frequency of this operation is the result of inadequate medical care. First of all, it is the patient's unwillingness to get it, and secondly, the irrationality of modern protocols for the treatment of fibroids.

Hysterectomy produce:

  • Tumor more than 14 weeks.
  • Tumor growth more than 4 weeks per year.
  • The presence of concomitant pathology of the endometrium, associated with a high risk of cancer.
  • Significant severity of clinical symptoms that are not amenable to other types of treatment.

Pregnancy and uterine fibroids

The course of pregnancy after the conservative removal of uterine fibroids is very much dependent on the technique of surgical intervention.

If the operation for uterine fibroids was accompanied by coagulation (cauterization) of the myomatous node bed without its closure, then there is a great risk of uterine rupture during pregnancy. And this is accompanied by massive bleeding, which can be fatal for a woman, and cause fetal death.

However, even if the correct closure was performed, the risk of rupture at the end of pregnancy and during childbirth also exists, but it is much lower. Therefore, these women require constant attention from obstetricians.

If the pregnancy has occurred against the background of existing fibroids, then the risk of pregnancy complications that are not associated with the presence of a uterine scar increases:

  • Placental insufficiency, disrupting the normal development of the baby.
  • The threat of interruption.
  • Incorrect location of the placenta and its detachment.

In childbirth increases the likelihood of weak labor forces, bleeding and acute hypoxia of the fetus. Therefore, when diagnosed with myoma, it is first recommended to treat it (the best option at the present time is medication, ie, “Esmia”), and then plan the pregnancy.

Disease prevention

Currently, there are indeed measures to prevent this disease, given the recently discovered pathogenetic features of fibroids (in 2013).

Therefore, in order to reduce the likelihood of this tumor, especially among women from the risk group (familial predisposition, black women, etc.), it is recommended:

  • Minimize the number of abortions, especially during adolescence.
  • Prevent inflammatory processes in the reproductive system.
  • Accept hormonal contraception if birth is not planned in the coming years. This will avoid unnecessary load on the body associated with ovulation and menstruation.
  • Treatment of painful periods (for this purpose, hormonal contraceptives and anti-inflammatory nonsteroids such as Ibuprofen are prescribed).
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